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BUILDING PERMIT APPLICATION <br />SAN JOAQUIN COUNTY COMMUNITY DEVELOPMENT DEPARTMENT <br />1810 E.HAZELTON AVENUE,STOCKTON CA 95205 <br />BUSINESS PHONE:(209)468-3121 <br />INSPECTION REQUEST-24 HOUR RECORDER:(209)468-3165 <br />THE APPUCJX:rION ~lJso(BE'G0MP~~+15l ~FitlfJ15(;j,~Ui'fimy,'[HEJXge~:I£~N1:JN"Qijlil~~lwQZ!1X:~~I$~~f,IOR' <br />".,._:,,.~'.,1BWJLPIN~H?ERMltJiS'.i.~_.~""d:.t1i.u~,,"',••.':'>'~.J""""...Ji,.'6.:.....:... <br />Scope of Work:5~CcrrJJ>UfJ\1"~W ta...L \r-16 2'2:2.1>S I po\., <br />Project Address:~40S~\{\b)\~2(P ~BAL!>(.~~""I.-~J )n,(.IG~ <br />Project Valuation:t z ?0,0 o 0,00 Contact E-mail: <br />OWNER NAME AND ADDRESS APPLICANif NAME AND ADDRESS <br />Name:GAf<l..I,)r-t"Di)Name:?«~S1b.kA\I<."~ <br />Address:14'2 15At-[)vJ ,J LeJ Address:5b8 AJvv1 if <br />City:STVCK.TO~State:Cjr City:~~p State:CA <br />ZIP:95'2./5"Ph#()Of 13/-~jIg ZIP:qS2~}Ph#(.?01)1!3 -'{9 (2.; <br />CONTRACTOR INFORMATION Ph#() <br />Lie.No:Company Name: <br />Address:City:"SI:ZIP: <br />[)ESIGNER INFORMATION Ph#.D.of)993 -9'b/-:l- <br />Lie.No:Company Name:51A~S~~-J>ftA(:'\\~Er 5~Vlc£' <br />Address:51"s;;.ArYl <.f cr:City:~C#-CA-wt P SI:'CA-ZIP:q~'2.3J <br />LENDING AGENCY .,~Ph#() <br />Company Name: <br />Address:City:St:ZIP:. <br />Permit will be issued to an "Owner-Builder"Yes 0 No 0 OFF-lyIAL USE ONLY <br />If yes,a completed Owner-Builder Verification Form must Identification Number: <br />be signed and submitted along with copy of the owner's <br />identification prior to issuance of the building permit <br />'.' <br />DEGL:~RATiON'~Y ~ON~;r~liyLI9~\:!=R~IT A~rHCA~T "~~"~,.::'~'~...'"',',,";{f~L.,;:i '.••1· <br />By my signature below,I certify to one of the following: <br />I am 0 a California licensed contractor or 0 the property owner or 0 authorized to act on the property owner's <br />behalf (requires written approval and Owner/Builder Verification Form signed and submitted). <br />- <br />I have read this construction permit application and the information I have provided is correct <br />I agree to comply with all applicable county ordinances and state laws relating to building construction.I authorize <br />representatives of this city or county to enter the above-identified property for inspection purposes. <br />Applicant's Signature ~~Date IZ/3J I/oII <br />For your convenience checklists detailing any additional submittal requirements for various building permit types <br />are available at the Building Division counter.Demolition permit and mobile home on foundation require check- <br />list. <br />F:\Application Forms &Handouts\HANDOUTS\Building Permit Application,docPage 1 of 2 <br />(Revised (07-08-10)